The kidneys came out first. Then the team began another delicate dissection, to remove an organ that is rarely, if ever, taken from a donor. Ninety minutes later they had it, resting in the palm of a surgeon’s hand: the uterus.
The operation was a practice run. Within the next few months, surgeons at the Cleveland Clinic expect to become the first in the United States totransplant a uterus into a woman who lacks one, so that she can become pregnant and give birth. The recipients will be women who were born without a uterus, had it removed or have uterine damage. The transplants will be temporary: The uterus would be removed after the recipient has had one or two babies, so she can stop taking transplant anti-rejection drugs.
Uterine transplantation is a new frontier, one that pairs specialists from two fields known for innovation and for pushing limits, medically and ethically — reproductive medicine and transplant surgery. If the procedure works, many women could benefit: An estimated 50,000 women in the United States might be candidates. But there are potential dangers.
The recipients, healthy women, will face the risks of surgery and anti-rejection drugs for a transplant that they, unlike someone with heart or liver failure, do not need to save their lives. Their pregnancies will be considered high-risk, with fetuses exposed to anti-rejection drugs and developing inside a womb taken from a dead woman.
Eight women from around the country have begun the screening process at the Cleveland Clinic, hoping to be selected for transplants. One, a 26-year-old with two adopted children, said she still wanted a chance to become pregnant and give birth.
“I crave that experience,” she said. “I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”
She traveled more than 1,000 miles to the clinic, paying her own way. She asked that her name and hometown be withheld to protect her family’s privacy.
A Temporary Transplant
Doctors at the Cleveland Clinic are preparing to transplant a uterus into a woman who lacks one, so she can become pregnant and give birth. If the procedure is successful, any children would be born by cesarean section and the mother would have the transplanted uterus removed after having one or two babies.
She was 16 when medical tests, performed because she had not begun menstruating, found that she had ovaries but no uterus — a syndrome that affects about one in 4,500 newborn girls. She comes from a large family, she said, and always assumed that she would have children. The test results were devastating.
Dr. Andreas G. Tzakis, the driving force behind the project, said, “There are women who won’t adopt or have surrogates, for reasons that are personal, cultural or religious.” Dr. Tzakis is the director of solid organ transplant surgery at a Cleveland Clinic hospital in Weston, Fla. “These women know exactly what this is about,” he said. “They’re informed of the risks and benefits. They have a lot of time to think about it, and think about it again. Our job is to make it as safe and successful as possible.”
The hospital plans to perform the procedure 10 times, as an experiment, and then decide whether to continue. Dr. Tzakis said he hoped to eventually make the operation readily available in the United States.
Sweden is the only country where uterine transplants have been completed successfully — all at the University of Gothenburg with a uterus from a live donor. Nine women have had them, and four have given birth, the first in September 2014. Another is due in January. Their babies were born healthy, though premature. Two transplants failed and had to be removed, one because of a blood clot and the other because of infection.
Two earlier attempts — one in Saudi Arabia, and one in Turkey — failed. Other hospitals, in the United States and in Britain, are also preparing to try the surgery, but are not as close as the team in Cleveland is.
Dr. Tzakis said the anti-rejection drugs were safe, noting that thousands of women with donor kidneys or livers, who must continue taking anti-rejection drugs during pregnancy, had given birth to healthy babies. Those women are more likely than others to have pre-eclampsia, a complication of pregnancy involving high blood pressure, and their babies tend to be smaller. But it is not known whether those problems are caused by the drugs, or by the underlying illnesses that led to the transplants. Because the women receiving uterine transplants would be healthy, Dr. Tzakis said, he was optimistic that complication rates would be very low.